The Role Of A Geriatric Doctor
Geriatric medicine is a difficult but rewarding profession. Care for older adults can be challenging as many cases are complex and involves caring for patients with multiple chronic conditions, and a geriatrician should have sound knowledge of medical ethics, social care and palliative medicine which are all largely important in their career.(1)
Performing a comprehensive and holistic assessment of an older person, determining a patient’s suitability for continuing care either in the NHS or within their community, and assessing the outcome of physiotherapy are all part of a geriatrician’s job. The main subspecialty in geriatrics is stroke medicine, which requires some additional qualifications to complete, and there are opportunities to take a special interest in other parts of geriatrics, including for example dementia or falls.(1)
The RCP 2011 showed that 33% of geriatric medicine consultants were female and 67% were male, while 56.7% of geriatrics registrars were female and 44.3% were male.(2) This suggests an increased number of women going to work in geriatric medicine.
Geriatricians jobs are mainly found in hospitals, dealing with acute care patients in A&Es, outpatient departments and acute care wards, but may also work in rehabilitation wards, long-term care wards or in the community in day-care centres, care homes or hospices.(3)
They work in close communication with GPs, other hospital specialists, nurses, social workers, carers and many others.(3) There are plenty of research opportunities within the specialty with a wide range of topics such as exploring the possibility to slow down or reverse the frailty trajectory, or research in applied geriatrics to find the best way to care for the elderly.(1)
A Typical Day & Workload
The working days are quite regular, typically 9-5, however many trainees choose to obtain a dual CCT in general internal medicine and geriatrics, and therefore need to commit to on-call rotas as well, which includes 12-13 hours long day shifts and night shifts.(1)
In addition to on-call work, geriatricians will complete ward rounds, carry out outpatient work and often also work in community settings.(4) Doctors also need to allocate time for administrative work, teaching, examining and research.
The Path To Becoming A Geriatrician
Trainees can choose between two pathways for the first stage of training: either a two-year core medical training programme (CMT), or a three-year acute care common stem (ACCS) programme. Before applying for higher specialty training, the applicants must have completed the Membership of the Royal College of Physicians UK.(5)
Entry to ST3 in geriatric medicine is by competitive application with the 2019 competition ratio of 1.18 applicants per post.(6) Geriatric medicine higher specialty training usually lasts four years, and most geriatric medicine trainees opt for a dual accreditation programme with general internal medicine, but there is an option for single CCT in geriatrics.(7) Trainees who decide to specialise in stroke medicine will require a further 6 months to one year of dedicated stroke straining before obtaining their CCT.(1,7)
Formative and practical assessment will be carried out all throughout the specialty training.(7) At the end of higher specialty training, trainees sit a summative Specialty Certificate Examination, and all geriatric medicine trainees also need to obtain Advanced Life Support Certificate to complete their specialty training.(1,7)
There is an option to undertake a training programme that includes Academic Clinical Fellowships during core training, which include a period of full-time research to undertake a PhD.(1) This leads to a position as an Academic Clinical Lecturer, which allows for a 50/50 combination of academic and clinical work.(1,5)
Research opportunities are also available to those doing regular clinical training.(5)
Medical students interested in geriatrics should try to get involved with the GMC and British Geriatrics Society and become a BMA student member.(5)
It is recommended that foundation trainees apply for general internal medicine rotations as well as geriatrics as there might not be vacancies in geriatrics and talk to their supervisors about gaining more experience in the specialty via taster experiences or placements. Foundation trainees should also take part in clinical audit and try to gain teaching and management experience, and make sure their e-Portfolio is up to date.(5)
Core and specialty trainees should focus on building sound knowledge of general internal medicine and explore geriatrics by speaking to experienced doctors in the specialty and researching websites of relevant professional bodies to gain more information about geriatric medicine.(5) Trainees are also encouraged to take up research, join journal clubs and try to get published and present their work in conferences.(5)
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
Foundation trainees will earn a basic salary of £28,243 to £32,691 and specialty trainees will earn a basic salary of £38,693 to £49,036.(9)
Geriatric medicine consultants have some potential for private practice with mean income about 20% of NHS earnings.(8) This is comparable to specialties such as haematology and psychiatry but much less than plastic surgery (190%).
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
Before applying for specialty training in geriatric medicine, applicants should carry out their own research into the specialty. Websites of professional bodies such as the GMC, the British Geriatrics Society, and Joint Royal Colleges of Physicians are good resources for this. There is also a variety of other resources available, such as Care of the Elderly podcast (CotEcast) and Focus on geriatric medicine and ageing podcast, and books such as the Oxford Handbook of Geriatric Medicine.
Related Job Sources With BMJ Careers
Other Complete Guides By BMJ Careers
A Career in Geriatric Medicine, British Geriatric Society, Published 22 May 2018, last updated 06 Aug 2019, date accessed Jun 2020, https://www.bgs.org.uk/resources/a-career-in-geriatric-medicine
Geriatric medicine workforce planning: a giant geriatric problem or has the tide turned?, J M Fisher et al, Clinical Medicine journal RCP London, PubMed Central, published Apr 2014, date accessed Jul 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953277/
Geriatric medicine, Health careers NHS, date accessed Jul 2020, https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/geriatric-medicine
Working life (GM), Health careers NHS, date accessed Jul 2020, https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/geriatric-medicine/working-life
Training and development (GM), Health careers NHS, date accessed Jul 2020, https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/geriatric-medicine/training-and-development
Specialty recruitment competition ratios 2019, Specialty training Health education England NHS UK, date accessed Jul 2020, https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202019_1.pdf
Draft Curriculum for Geriatric Medicine Training (implementation Aug 2020), Joint royal college of physicians training board, date accessed Jul 2020, https://www.jrcptb.org.uk/sites/default/files/DRAFT%20New%20Curriculum%20Geriatric%20Medicine%20v15%2005%20Mar.pdf
Conditional mean income by specialty sorted by ratio of private income to NHS income Table 3, Journal of the royal society of medicine, Pub Med Central, published 1st Jul 2008, date accessed Jul 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442143/table/tbl3/
Pay for doctors, Health careers NHS UK, date accessed Jul 2020, https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-doctors